ABSTRACT In 2010 the National Collegiate Athletic Association (NCAA) adopted a mandatory sickle cell trait (SCT) screening policy for student-athletes in its Division I (DI) colleges and universities. Currently, schools in all three divisions of the NCAA are implementing the policy. To date, very little published research is available on SCT in student-athletes or on the actual implementation of the NCAA screening policy. Many important questions remain regarding this controversial mandated genetic screening program. Results from a preliminary study we conducted of NCAA DI institutions in North Carolina reveal that athletic staff at most of the schools found it beneficial to know the SCT status of their student-athletes, but felt they need clearer guidance and instructions from the NCAA on the policy implementation. We also found that that some athletic staff and student-athletes believed that black students were the only ones at risk and should be the targets for screening. There has been little education for coaches, athletic trainers, and student-athletes on reasons for screening all student-athletes. Of the few student-athletes with SCT in our sample, only about one-half changed the way they participate in their sport based on their status. These and our other preliminary findings provide important information concerning the procedures, perspectives, and behavioral outcomes at some institutions in one US state. A larger and more representative sample is needed to better understand the policy?s challenges, limitations, and risks, and to develop strategies to address them. This proposal builds upon our previous work in North Carolina. The Specific Aims are to: 1) assess implementation, risks, and secondary benefits of the NCAA SCT screening policy and determine contributors to and implications of variation within these domains and 2) provide guidance on the current NCAA SCT policy and practice and other similar public health policies and practices. For Aim 1, data will be generated from online surveys and semi-structured telephone interviews with athletic staff and student-athletes at NCAA DI, DII, and DIII colleges and universities. For Aim 2, we will collaborate with the NCAA to convene a national summit involving selected stakeholders at institutional and policy levels to review the findings from Aim 1 and develop best practice recommendations for future implementation of the SCT screening policy. The proposed research will provide unprecedented and invaluable information on the procedures, perceptions, and outcomes of the NCAA SCT screening policy. It will uncover real and perceived benefits, risks, and effectiveness of the policy, and facilitate efforts to address the areas of concern. The project will also establish a useful empirical foundation for decision-making concerning future implementation of the NCAA policy and similar policies and programs aimed at preventing illness and protecting the public?s health.